Use of Hallway Beds, Radiology Studies, and Patients in Pain on Arrival to the Emergency Department Are Associated With Patient Experience.

Abstract

STUDY OBJECTIVE Patient experience is an essential measure of patient-centered emergency care. However, emergency department (ED) patient experience scores may be influenced by patient demographics as well as clinical and operational characteristics unrelated to actual patient-centeredness of care. This study aimed to determine whether there are characteristics associated with patient experience scores that have not yet been proposed for risk adjustment by the Centers for Medicare and Medicaid Services (CMS). METHODS This is a cross-sectional study of patient visits for 13 EDs across a regional health system from January 1, 2022, to December 31, 2023. We used a multivariable mixed-effects regression with physician-site random effects to examine the relationship between patient, clinical, and operational characteristics and ED patient experience scores. The dependent variable was a patient's likelihood to recommend rating (0-10 scale), treated as a continuous variable. The independent variables included patient (age, race, gender, ethnicity, interpreter need, and payer type), clinical (radiology and laboratory studies, opioid administration, patient acuity, and initial pain score), and operational characteristics (door-to-doc times, hallway bed placement, and National Emergency Department Overcrowding Scale [NEDOCS] level). RESULTS A total of 58,622 unique patient visits were included in the analysis. The patient experience survey response rate was 7.1% of discharged ED patients during the study period. Black or African American patients, those with Medicaid insurance, and adults aged younger than 40 years were underrepresented relative to the expected proportions based on population data. Several clinical and operational characteristics were significantly associated with experience ratings, including hallway bed placement (-0.38 [95% confidence interval, -0.53 to -0.23]), receiving radiology studies (0.27 [0.20 to 0.35]), initial pain scores (-0.08 [-0.09 to -0.06]), and NEDOCS level. CONCLUSION We found several clinical and operational characteristics associated with patient experience scores, which CMS does not currently use for risk adjustment. Our findings raise concerns that there are elements of care associated with patients' overall experience ratings which have an unclear relationship with patient-centered constructs such as communication and coordination of care.